TMJ Exam and Inverventions Flashcards
List some common functional limitations that may be observed in someone with TMD
- chewing
- eating
- talking
- sleeping
- work tasks (clenching with prolonged sitting for ex)
what should be included in the patient interview?
- History of Previous Injury (HPI)
- Primary (and secondary) complaints
- Associated symptoms
- HA (location, frequency, visual aura)
- Dizziness/Nausea (vertigo, lightheadness)
- Paresthesia/Anesthesia of face/scalp or body
- Tinnitus
- Special questions
- Previous intervention and response
- medication list
What special questions should be included in the pt interview?
- Joint noises
- clicking/popping
- crepitus
- Parafunction
- Locking
- Catching
- Hx of Open lock
List some outcome measures that you may include/see in a pt interview for someone with TMD
- PSFS
- Tampa Scale of Kinesiophobia for TMD
- Tempormandibular Pain Disorder Screening Instrument
What things should be included in the visual inspection of a pt with TMJ issues?
- Posture
- Craniofacial-specific observations
- face type/shape
- occlusion
- facial symmetry
- Intra-oral inspection
- scalloping
- teeth
- lesions
List several types of malocclusions that may be observed during the visual inspection
- Open Bite (space between front teeth when mouth is closed)
- Retrognathism (Overjet)
- Prognathism
Describe the proposed mechanism for forward head posture
passive tension by supra and infrahyoids alter resting position of the mandible
mandible is pulled inferiorly and posteriorly, changing position of the mandibular condyle on the cranium
List elimination tests that should be included for the TMJ
- UQS
- Initial TMJ screening
- Neuro screening tests
- cranial nerve testing
- test for UMN and LMN
- Other special tests
List special elimination tests for the TMJ
- Gross TMJ AROM
- motions → opening, clenching, protrusion
- symptoms → provocation of concordant pain
- signs → joint noises, quality of motion, gross quantitiy of motion
- Cervical flexion and rotation test
how should you be positioned during AROM testing (structural stress testing) for the TMJ?
eye level at pt’s level of the TMJ
*assess pt’s comfortable starting position and take into account
what types of deviations should you be mindful of during AROM testing of the TMJ?
- C-type curve
- S-type curve
what motions are included in AROM and PROM for TMJ?
- Opening
- Protrusion
- Retraction
- Lateral deviation (bilateral)
List extra-oral palpation sites for the TMJ
- Temporalis
- Masseter
- Medial Pterygoid
- TMJ Joint line
- Supra-hyoids
- SCM
- cervical paraspinals
- Zygomatic arch
List intra-oral sites for palpation of the TMJ
- M/L Pterygoid
- Temporalis tendon
- Masseter
- Teeth
- Gum line
What directions are assessed with joint mobility testing of the TMJ?
- Cuadal Glide (inferior)
- Ventral glide (anterior)
- Medial glide
- intra and extra oral
- Lateral glide
- intra and extra oral
List confirmation tests for TMJ issues
- Auscultation of TMJ w/stethoscope during AROM
- Provocation Test
- Unilateral tongue depressor biting
describe how to perform the provocation test
for retrodiscal material
unilateral in sequence → distraction, retrusion, cranial displacement, protraction
compression of intra-articular tissue between mandibular condyle and cranial articulation
describe how results of the unilateral tongue depressor biting test can be interpreted
ipsilateral provocation → capsular
contralateral provocation → compression loading on intra-articular soft tissue structures
List some intervention options for TMJ
- Pt reassurance and education
- Occlusal appliances
- Exercise
- Referral if appropriate
- Manual therapy
- Surgery
- Joint mobilizations
- Soft tissue mobilizations
Pt education for TMD should include what?
- activity modification → avoid loading of the joint and control parafunction
- sleep position, maintain resting position of TMJ, eating soft foods, avoid gum chewing
- Diagnosis, Prognosis, Goals, POC
- Relaxation techniques
Exercise interventions for TMD can include what?
- Mid and lower trap/deep cervical flexor/thoracic extensor coordination training (postural exercises)
- Upper quarter stretching
- TMJ muscle coordination exercises (isometrics, biofeedback)
- TMJ ARM → maintain motion, reduce contracture, improve muscle function
- Neuromuscular control exercises for TMJ muscles
What are the surgical options for TMD patients?
- Arthroplasty
- Orthognathic surgery
*~20% require surgical intervention
what types of joint mobilizations could you peform for TMD?
- Oscillations
- Sustained holds
what does research say in regard to manual therapy for TMD?
Level B evidence for manual therapy combined with exercises for trx of TMD, based on weak RCTs and case-series designs
What types/direction of joint glides can be peformed for TMD intervention?
- Cuadal glide
- Ventral glide
- Medial glide
- intra and extra-oral
- Lateral glide
- intra and extra-oral
